Provider Demographics
NPI:1831159516
Name:COOKE, JANE ELLEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELLEN
Last Name:COOKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HARDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2035
Mailing Address - Country:US
Mailing Address - Phone:610-970-5234
Mailing Address - Fax:610-970-0945
Practice Address - Street 1:595 BETHLEHEM PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9710
Practice Address - Country:US
Practice Address - Phone:610-970-5234
Practice Address - Fax:610-979-0945
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW014098OtherSOCIAL WORK LICENSE